Infant Mental
Health

Bessborough Child and Family Services recognise Infant Mental Health as crucial for the long term emotional and psychological wellbeing of children

Infant Mental Health:

Infant Mental health is the developing capacity of the child from conception to three years of age to:

  • Experience, regulate and express emotions
  • Form close interpersonal relationships with peers and adults
  • Explore the environment and learn

Babies and infants develop in relationship to their primary caregivers. Research has shown that early experiences build brain architecture, with 90% of brain growth happening by 6 years of age. Memories develop young and are often non-conscious. Our brains are social and relational (e.g. we have mirror neurons which allow us to learn through imitation) and thus infants brains develop through interactions with their primary caregivers (parents/carers).

Infants develop positive mental health through consistent, responsive and loving care and attention from their caregivers.

We believe our personalities and functioning ability in a wide range of areas is directly related to our sense of safety and emotional experiences, and the quality of our caregiving relationships, in early childhood. 

Attachment and Infant Mental Health

Infants develop positive mental health through receiving consistently responsive, sensitive and loving care from their parents/carers, so that they feel loved and secure. This is a central part of the attachment relationship, where the primary caregiver provides the infant with a secure base from which to explore and, when necessary, provides a haven of safety and a source of comfort. This teaches infants that the world is a safe place, helping them to develop ‘inner working models’ or representations of themselves as worthwhile and of relationships as safe and trustworthy.

Parental reflective functioning or mentalising ability also plays a key role in the developing attachment relationship and positive infant mental health. This involves parents and carers ability to recognise their infant’s behaviour in terms of their infant’s mental states (feelings, thoughts), which are separate and different from their own.

Attachment plays a key role in affect regulation (ability to manage feelings and emotions consciously and unconsciously). Attachment experiences impact on emotional regulation and how infants, children, adolescents, and adults, manage stress. Attachment styles where caregivers are expected to be unavailable or rejecting when needed [insecure attachment] can contribute to toxic stress and difficult with relationships and emotion regulation.

Insecure attachment can leave infants more vulnerable to emotional and psychological difficulties later in life, along with other factors such as genetic, developmental, abuse and trauma, and cultural/environmental factors.

Therefore it is important to support the developing attachment relationship between parent and infant, i.e. parent/carers ability to provide warm, loving, responsive and sensitive interactions with their infants, as well as their ability to think about their infant’s thoughts, feelings and behaviours.

What happens if infants or children do not have positive supportive early relationships?

  • Infants can seem sad, lethargic, angry or even depressed
  • They may develop eating or sleeping problems
  • They may rely on themselves for comfort and nurturing
  • They may seek attention from any adult, which may place them at risk
  • They may not meet their developmental milestones
  • They may have behavioural and emotional difficulties as they get older as they struggle with emotional regulation
  • They may have very low self-worth, lack of confidence and self-belief
  • When babies fail to elicit responses or are overwhelmed by intrusive responses, they will eventually stop trying to engage

An ever-expanding evidence and literature base shows good infant mental health is synonymous with healthy development. Infants emotional, social, cognitive and physical development are interconnected and depend on each other, for example a child’s ability to learn new skills is dependent on their ability to interact with others and to manage their emotions effectively.

Parents and caregivers can be the source of their babies’ distress by being:

– Overstimulating
– Confusing
– Rejecting

– Dismissive
– Unresponsive
– Angry and frightening

What would babies tell
us if they had words?

  • “From the moment I was born I was ready to connect with you”
  • “Hold me, cuddle me and look into my eyes”
  • “Respond kindly to me when I cry as my cry is my way of communicating with you”
  • “Talk to me and pause so I can respond in my own way”
  • “Play with me each day giving me your full attention and sharing enjoyment with me”
  • “I like consistency and routines so I can learn to predict what we are going to do and how you are going to respond”

Top tips for parents and carers

  • Attunement means noticing and responding to our baby’s cues or signals to meet their physical and emotional needs.
  • This involves learning how they communicate, such as:
  • their different cries
  • their smiles
  • when and why they stick out their tongue
  • when they turn their head away (usually when they are tired or need a break)
  • their little noises and babble sounds
  • their sleepy signs
  • how they move their bodies when excited or upset.
  • All babies have different developing personalities (their temperament). Some babies can be slower to warm up or more sensitive to different environments. Keeping their environment calm and having a routine is important for all babies, but in particular for more sensitive babies, and new experiences should be introduced slowly for them.
  • This means showing warmth and love to infants.
  • It also means responding in loving ways when they are upset such as picking them up promptly, cuddling them and soothing them.
  • This is part of helping babies to manage or regulate their emotions, called co-regulation.
  • Parents and carers help their babies to manage their feelings by:
  • – Comforting them and helping them to manage their feelings through holding and talking gently to our babies: ‘there there, I know you have a pain in your tummy, I’m here’.
  • – Thinking about and showing our babies that we understand their feelings (or that we are trying to!).
  • – Responding in a timely manner – not leaving babies to ‘cry it out’ or in distress for a long time.
  • – Staying calm and taking care of ourselves as this can be hard.
  • This involves ‘back and forth interactions between you and your baby, like a tennis match.
  • Your baby ‘serves’ by reaching out for an interaction through eye contact, gestures, facial expressions, babbling or touch.
  • The parent/carer responds in turn ‘returning the serve’ by noticing what your baby is doing or looking at, responding and talking to them, playing with them, or sharing a toy or laugh and allowing your baby to respond in turn again.
  • Play is an important part of a parent-child relationship. Play is develops imagination and helps children to learn and make friends.
  • Play may be difficult for some parents or they may not know how to play.
  • Some tips for play are:
  • – create a safe play environment with age appropriate toys within reach for your child
  • – following your child’s lead in play – watching what your baby is drawn to and what they find interesting
  • –  talk to your baby about what they are doing and how they may be feeling
  • –  following serve and return interactions (as above)
  • –  reading, singing nursery rhymes and songs
  • – knowing that you are your child’s best toy!
  • Consistent care is important for babies along with some routines (e.g. sleeping and feeding) for infants to predict what is going to happen next, which can help them feel more secure
  • Parents and carers are not perfect and will make mistakes sometimes. What is important is that we try to repair this, by noticing if we have tuned out from our baby or are finding it hard to understand what they need or to comfort them. We can then show our baby we are still there for them.

Babies have powerful feelings and need you to help to manage them.

Babies cry because they need you to help them.

Try to think about how your baby is feeling. Ask yourself ‘what might my baby be trying to tell me, what might they be feeling?

Think about how you feel when you are hungry, tired, overwhelmed or scared.

Soothe and reassure your baby when they are upset by holding them close, cuddling, rocking, singing or talking softly to them as well as meeting their physical needs such as hunger or tiredness.

Remember to look out for ‘Serve and Return’ moments – ‘return the serve’ to your baby when they ‘serve’ to you.

Useful Websites

HSE

Circle of Security International

Zero to Three

Irish Association for Infant Mental Health

Young Knocknaheeny Area Based Childhood Programme

Centre on the Developing Child, Harvard University

Anna Freud National Centre for Children and Families

World Association for Infant Mental Health

Academic References

Ainsworth, M. S. (1989). Attachments beyond infancy. American Psychologist, 44(4), 709–716

Bowlby, J. (1988) A Secure Base: Parent-Child Attachment and Healthy Human Development. New York, Basic Books

Cassidy, J., Jones, J. D., & Shaver, P. R. (2013) ‘Contributions of Attachment Theory and Research: A Framework for Future Research, Translation and Policy’ Developmental Psychopathology, 25(4): 1415-1434

Benoit, D. (2004). ‘Infant-parent attachment: Definition, types, antecedents, measurement and outcome.’ Paediatric Child Health, 9(8):541-545.
Ellis, W., & Dietz, W. (2017). ‘A New Framework for Addressing Adverse Childhood and Community Experiences: The Building Community Resilience Model’, Academic Paediatrics, 17 (7S).

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

Fonagy, P. (2001) Attachment Theory and Psychoanalysis. Karnac Books
Mikulincer, M. & Shaver, P. R. (2012) ‘An attachment perspective on psychopathology’ World Psychiatry, 11: 11-15

Schore, A. N. (2003a) Affect dysregulation and disorders of the self. New York: W. W. Norton

Schore, A. N. (2003b) Affect regulation and the repair of the self. New York: W. W. Norton

Schore, J. R. & Schore, A. N. (2008) ‘Modern Attachment Theory: The Central Role of Affect Regulation in Development and Treatment’ Clinical Social Work Journal, 36(1): 9-20

Siegel, D. (2001) ‘Toward an Interpersonal Neurobiology of the Developing Mind: Attachment Relationships, ‘Mindsight’ and Neural Integration.’ Infant Mental Health Journal, 22(1-2): pp. 67-94

Slade, A. (2005) ‘Parental reflective functioning: an introduction’. Attachment and Human Development, 7: pp. 269-281

Tronick, E. & Beeghly, M. (2011) ‘Infants’ meaning making and the development of mental health problems’ American Psychologist, 66: pp. 107-119

Van der Kolk, B. (2015) The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma. Penguin Psychology
Winnicott, D. W. (1988) Human Nature. London: Free Association Books